Paul Ryan’s Misguided Sense of Freedom

In his first address to Congress, President Trump made many sweeping pledges, but one of them was familiar to anyone who listened to him campaign. He said that he was “calling on this Congress to repeal and replace Obamacare” and demanding “reforms that expand choice, increase access, lower costs and, at the same time, provide better health care.”

That’s a lot to promise, and Republicans have thus far been unable to get on the same page about how to repeal the Affordable Care Act and what should take its place. But Mr. Trump is not the one who has to deliver on it. It falls to House Speaker Paul Ryan to rally the troops.

For his part, Mr. Ryan has been diligently tweeting pledges to the American people that the law is on its way out. Republicans haven’t landed on a replacement plan yet. But Mr. Ryan is sure they will come up with something because they know, as he said in a recent tweet, “Freedom is the ability to buy what you want to fit what you need.”

He went on to argue that Obamacare abridges this freedom by telling you what to buy. But his first thought offers a meaningful and powerful definition of freedom. Conservatives are typically proponents of negative liberty: the freedom from constraints and impediments. Mr. Ryan formulated a positive liberty: freedom derived from having what it takes to fulfill one’s needs and therefore to direct one’s own life.

In so doing, Mr. Ryan inadvertently revived an idea that desperately needs to be resuscitated — the idea that freedom requires not just a lack of barriers, but also the conditions that allow people to live their lives fully. Deprivation, then, is a constraint on Americans’ freedom.

This conception harks back to President Franklin D. Roosevelt’s Four Freedoms. In his third term, Roosevelt delivered a State of the Union address that outlined four core principles, freedom from want among them. He later built on that idea and proposed a second Bill of Rights for every citizen. “True individual freedom cannot exist without economic security and independence,” he declared. “ ‘Necessitous men are not free men.’ ”

Among the rights he laid out were to a job and an education, to earn enough to buy the necessities, to live in a “decent home,” and to medical care and good health.

An error has occurred. Please try again later.

You are already subscribed to this email.

That last right, of course, is what Mr. Ryan was threatening in his tweet. The Affordable Care Act’s extension of health care coverage, coupled with the individual mandate to buy it, has brought the uninsured rate to an all-time low. Some studies have found that this has had a positive impact on low-income Americans’ health, freeing them from constant worrying about injury and illness.

It’s also making them economically freer. Medical debt has long been one of the biggest drags on Americans’ finances. But gaining health insurance through the A.C.A.’s Medicaid expansion, for example, saved enrollees money on their health care. They then used that money to pay down debts.

Separating health insurance from employment has also freed people to pursue the work they want to be doing. Health care expansions can decrease “job lock,” the phenomenon of people staying in jobs because they can’t afford to strike out on their own and lose their insurance. Preliminary research indicates this may be happening for Americans who can fall back on the A.C.A. Nearly one and a half million self-employed people and small-business owners got coverage through its exchanges in 2014.

Republicans promise to replace the Affordable Care Act with something better, although they haven’t agreed on what that will be. What they can say is that it will be teeming with freedom. With the exception of Mr. Ryan, theirs is a negative freedom: a drop in the insurance rate would be a positive sign of the “personal liberty” of not being subject to the individual mandate, for example. Their plan will be built on “freedom and individual responsibility.” A constraint would be lifted. Who cares if uninsured people suffer because they can’t get medical care?

It’s not just health insurance coverage, though, that ensures a person’s freedom. It’s difficult to pursue one’s dreams on an empty stomach. How do you start a business without being able to afford rent?

That reality demands a more extensive agenda than government-expanded health insurance. It mandates that Americans be guaranteed enough food to eat, a safe and affordable place to live and a sufficient source of income.

All of this is in opposition to Mr. Ryan’s ideas. He rose to prominence by releasing a series of budget blueprints that proposed slashing government spending by trillions of dollars. And in every single one, about two-thirds of those cuts are visited upon the things that already help people with limited means survive, such as food stamps, Pell Grants for education and programs that boost their incomes.

Even though Mr. Ryan says he believes that freedom is “the ability to buy what you want to fit what you need,” he doesn’t want the government to do anything to help people experience that freedom. If he got his way on spending, the programs that allow the poor and struggling to buy food, housing and the other things they need would be utterly debilitated. The rich are the only ones who could be truly free in his vision of the country.

But he has reintroduced a potent definition of freedom. We need to reclaim it.

Bryce Covert is the economic policy editor at ThinkProgress and a contributor to The Nation.